Montana Healthcare Programs Provider Enrollment


Individual Providers

Montana Medicaid has three enrollment types for individual providers:

  • Sole Proprietor Provider
  • Rendering Provider
  • Ordering/Referring/Prescribing Provider

These enrollment types have different functions and requirements.

Sole Proprietor Provider

A provider who owns their own business and the associated tax ID.

They will be used as the pay-to provider on a claim, and they are the direct recipient of payment from Montana Healthcare Programs.

This enrollment type is appropriate for individuals who own their own practice and do not employ other individuals. Providers who are sole proprietors can also work part-time at another organization and be used as a rendering provider on the organization’s claims. However, they do not need to add a location to their sole proprietor enrollment for the other organization for whom they are working.

Individual providers who are sole proprietor providers are not allowed to share a tax ID with an organization NPI or another individual NPI. Any individual providers currently enrolled under a shared tax ID with an organization or individual would need to be disenrolled and reenrolled.

The options for re-enrollment would be:

  • As an individual sole proprietor provider under their SSN or a private practice tax ID
  • As a Rendering only provider.
If your individual sole proprietor provider is due for revalidation and shares a tax ID with an organization or another individual NPI, refer to the instructions above.

Revalidations submitted for a sole proprietor under a shared tax ID will be denied. The submitting party will be notified of the denial and provided instructions on how to disenroll and re-enroll.

Rendering Provider

The individual who sees patients directly but works for a group, clinic, hospital, or other organization.

They are only used as a rendering or attending provider on a claim under an organization’s NPI. They do not receive payments directly from Montana Healthcare Programs. Rendering providers are not enrolled under a tax ID as they do not own one. Claims are used to associate the rendering provider to an organization. Rendering providers can practice at multiple locations. This enrollment type is appropriate for individuals who are employed by at least one organization and who are not expecting direct payment from Montana Healthcare Programs.

Ordering/Referring/Prescribing Provider

This provider does not bill for services and is not listed as a rendering provider on a professional claim.

They simply write orders, prescribe medications, and refer members for testing and to other providers. This is the correct enrollment type for individuals who only perform these functions and would be entered on an institutional claim form for Montana Healthcare Programs members.

Organization Providers

Montana Medicaid has two enrollment types for organization providers:

  • Group
  • Facility

There are different taxonomy codes available under these types.


This enrollment type will be a Group/Clinic under one of the taxonomy codes below. A provider enrolled in this type can add additional provider types and taxonomies under the NPI using the subparts feature on the Provider Information tab of the enrollment as needed and appropriate.

The two available taxonomy codes are:

  • 193200000X
  • 193400000X


This enrollment type encompasses all other taxonomies and provider types for organizations. This includes the other taxonomies that fall under the Group/Clinic provider type beginning with 261Q. This enrollment type will not have access to add the Group enrollment taxonomy codes. This enrollment type also has the option to add additional types using the subparts feature.

Selecting the correct enrollment type on your enrollment application can impact processing time and the amount of supporting documentation required.

If you have questions on which enrollment type is appropriate for you, contact Provider Relations at (800) 624-3958 or email

For more information on Medicaid Provider Requirements, refer to the Provider Requirements chapter of the General Information for Providers Manual.

Thank you for your interest in becoming a Montana Healthcare Programs provider.


Begin the Enrollment Process


If you have further questions about the completing enrollment application, please contact:
Montana Provider Relations
Provider Enrollment
(800) 624-3958
(406) 442-1837 (Helena/Local)


Enrollment Mailing address:
PO Box 89
Great Falls, MT 59403

Note: If you are mailing enrollment documents, you must use the Montana Provider Services Mail Cover Sheet found in the Enrollment Support Forms tab below.